OBJECTIVE: To describe the utilisation and safety of air medical services (AMS), when being used for inter-facility transfers of paediatric patients in the Western Cape Province, South Africa. METHODS: A retrospective descriptive analysis was conducted for the time period January 2010 to December 2011. Data were recorded from the Cape Town base of the AMS provider for the Western Cape Provincial Department of Health Emergency Medical Services. Patient demographics, flight and transfer details, interventions performed and adverse events encountered were documented for all patients <13 years of age transferred by either helicopter or fixed-wing aircraft. RESULTS: A total of 485 patients was analysed. More patients were transported by helicopter (n=263, 54%), with neonates making up the largest category for both modes of transfer. Respiratory (29%), neurological (18%), cardiac (14%) and gastrointestinal disorders (14%) made up the majority of non-traumatic reasons for transfer. Overall, transfers by helicopter were quicker (median mission time 03:00; interquartile range 02:32 - 03:25) compared with fixed-wing transfer (05:24; 04:22 - 06:20). The overall incidence of adverse technical events was relatively high (20%). Physiological adverse events ranged between 2% and 16% overall depending on the variable measured. The incidence of cardiac/respiratory arrest and endotracheal tube obstruction/dislocation was low (<2%). Emergency intubation and desaturation >10% from baseline were the most common critical adverse events encountered (6%). CONCLUSION: Current utilisation of the AMS for paediatric inter-facility transfer is relatively high, at ~25%. Across both the helicopter and fixed-wing platforms, patients with a diverse range of pathologies of equally varying severities were transferred. The adverse events observed were found to be lower than those of trials examining non-specialised paediatric transfer, and were comparable to those seen with transfer by specialised paediatric retrieval teams. The AMS remain a safe and viable alternative to non-specialised paediatric transfer, and may serve as a potential alternative to specialised paediatric transfer in the Western Cape.